Traditional Fermented Beverages of Mexico: A Biocultural Unseen Foodscape.

Mexico is one of the main regions of the world where the domestication of numerous edible plant species originated. Its cuisine is considered an Intangible Cultural Heritage of Humanity and ferments are important components but have been poorly studied. Traditional fermented foods are still diverse, but some are endangered, requiring actions to promote their preservation. Our study aimed to (1) systematize information on the diversity and cultural history of traditional Mexican fermented beverages (TMFB), (2) document their spatial distribution, and (3) identify the main research trends and topics needed for their conservation and recovery. We reviewed information and constructed a database with biocultural information about TMFB prepared and consumed in Mexico, and we analyzed the information through network approaches and mapped it. We identified 16 TMFB and 143 plant species involved in their production, species of Cactaceae, Asparagaceae, and Poaceae being the most common substrates. Microbiological research has been directed to the potential biotechnological applications of Lactobacillus, Bacillus, and Saccharomyces. We identified a major gap of research on uncommon beverages and poor attention on the cultural and technological aspects. TMFB are dynamic and heterogenous foodscapes that are valuable biocultural reservoirs. Policies should include their promotion for conservation. The main needs of research and policies are discussed.

Morphological and genetic diversity of traditional varieties of agave in Hidalgo State, Mexico.

The agaves are plants of cultural importance which have been used by humans for about 10,000 years and about 40 specific uses. The most culturally and economically important of those uses are for the production of fermented (pulque) and distilled beverages (mescal). Pulque continues to be produced in nearly all of Mexico, and the agaves used for this purpose have shown domestication syndrome. We carry out an ethnobotanical, morphological, and genetic analysis of the traditional varieties of pulque agave used in the production of aguamiel (agave sap) and pulque in the state of Hidalgo. We did semi-structured interviews, free listings, and tours with 11 agave managers. We analyzed morphology and studied genetic diversity and structure using nuclear microsatellites. We found wild-collected, tolerated, transplanted, and cultivated varieties of agave. This comprised 19 traditional varieties of pulque agave, 12 of them in production during the study, which corresponded to the species Agave americana, A. salmiana y A. mapisaga and five intraspecific entities. The varieties were grouped morphologically according to a management gradient; the wild-collected varieties were the smallest, with more lateral teeth and a larger terminal spine. The cultivated varieties clearly exhibited domestication syndrome, with larger plants and smaller dentition. The expected heterozygosity (He) of the varieties ranged from 0.204 to 0.721. Bayesian clustering suggested the existence of three genetic groups, both at the level of traditional varieties of pulque agaves and for management categories, a result that matches multivariate clustering. Pulque producers in the studied localities maintain high agrobiodiversity. The cultivated varieties exhibit domestication syndrome, as has been reported for other species of the genus with the same selection purposes. Our results support the hypothesis of a decrease in genetic diversity in crops compared to wild-growing agaves, which seems to be due to vegetative propagation, among other factors.

Physical, Chemical, and Microbiological Characteristics of Pulque: Management of a Fermented Beverage in Michoacán, Mexico.

Pulque is a beverage that has been prepared in Mexico since pre-Hispanic times from the fermented sap of more than 30 species of wild and domesticated agaves. We conducted studies in two communities of the state of Michoacán, in central-western Mexico, where we documented its traditional preparation and analyzed the relationship between preparation conditions and the composition and dynamics of microbiological communities, as well as the physical and chemical characteristics of the beverage. In one of the communities, Santiago Undameo (SU), people boil the sap before inoculating it with pulque inoculum; this action causes this local pulque to be sweeter, less acidic, and poorer in bacteria and yeast diversity than in the other community, Tarimbaro (T), where the agave sap is not boiled and where the pulque has more diversity of microorganisms than in SU. Fermentation management, particularly boiling of the agave sap, influences the dynamics and diversity of microbial communities in the beverage.

Management, morphological and genetic diversity of domesticated agaves in Michoacán, México.

BACKGROUND: Pulque is a fermented beverage prepared with sap of Agave species in Mexico. Management of agaves for this purpose has motivated domestication of some species and high phenotypic variation that commonly causes uncertainty about the taxonomic identity of varieties traditionally managed by people. This study assumed that varieties of crop species continually arise from mutations, sexual reproduction and hybridization, among other processes, and some of them are favoured and maintained by humans. Identifying these varieties may be difficult and a challenging issue for botanists and evolutionary biologists studying processes of domestication. Through a case study, we analysed the traditional varieties of agaves used to produce pulque in Michoacán, Mexico. We aimed at identifying the varieties, analysing the relatedness among them and developing a methodological approach that could help solve taxonomic problems and study variation under domestication of this and other plant groups. We documented (1) the traditional varieties of agave used and their identity, (2) how these varieties are perceived, used and managed by the local people and (3) how management influences phenotypic and genetic variation among varieties. METHODS: We interviewed pulque producers in two localities of the state of Michoacán, Mexico, where we recorded management practices of agaves, the traditional varieties used, the attributes characterizing those varieties, the varieties preferred by people, and features and mechanisms of selection. We conducted multivariate analyses of morphological features of the agave varieties, as well as genetic diversity and genetic distance studies among agave varieties through 11 nuclear microsatellites. RESULTS: Seven traditional varieties of Agave were recorded in the study area. Multivariate analyses of morphology identified varieties belonging to the species A. salmiana, A. mapisaga and, presumably, A. americana. The preferred varieties have morphological features selected to make easier their management and produce higher sap yields. Genetic diversities (HE = 0. 470 to 0.594) were high compared with other Agave species with similar life history traits and use. Genetic distance analyses grouped the varieties "Verde" and "Negro" (identified as A. salmiana), whereas the varieties "Tarímbaro" and "Listoncillo" (identified as A. mapisaga) formed another group. The varieties "Blanco" and "Carrizaleño" (most probably being A. americana) clustered with varieties of A. salmiana, whereas the variety "Cenizo" appeared as a distinct group. Bayesian analysis indicated that most individuals of varieties of A. salmiana form a group and those of the varieties of A. mapisaga form another, whereas individuals of the varieties putatively belonging to A. americana clustered in similar proportions with both groups. CONCLUSIONS: The traditional pulque production in the study area is an ongoing practice. It is still an important source of products for direct consumption by households and generation of economic incomes and as part of the cultural identity of local people. The most used traditional variety exhibited a marked gigantism, and although these agaves are mainly asexually propagated, populations have high genetic diversity. The local producers promote the maintenance of different traditional varieties. Our study shows the value of an integral research approach including ethnobiological, morphological and genetic information to clarify the state of variation influenced by humans on agaves, but it would be helpful to study other organisms under domestication. In addition, such approach would help to document human and non-human mechanisms generating crop varieties managed by local people.

Morphological and genetic divergence between Agave inaequidens, A. cupreata and the domesticated A. hookeri. Analysis of their evolutionary relationships.

Agave inaequidens and A. cupreata are wild species with some populations under incipient management, while A. hookeri is exclusively cultivated, used for producing the fermented beverage pulque. These species are closely related and sympatric members of the Crenatae group, but taxonomists have previously hypothesized that A. inaequidens is the most probable ancestor of A. hookeri. Our study aims at evaluating patterns of morphological and genetic divergence among populations of the three species, in order to analyze their ecological and possible evolutionary relationships. We studied 24 agave populations, 16 of them of Agave inaequidens, four of A. cupreata and four of A. hookeri. Population morphometric and genetics studies were performed using 39 morphological characters and 10 nuclear microsatellites, respectively. We estimated levels of morphological and genetic diversity and dissimilarity, as well as genetic structure and gene flow among populations and species. The three species were clearly differentiated by general plant size, lateral teeth, terminal spines, flowers and fruit size. The largest plants were those of A. hookeri followed by A. inaequidens and the smallest were A. cupreata. Multivariate analyses indicated greater morphological similarity between A. hookeri and cultivated A. inaequidens, while A. cupreata consistently appeared as a separate group. We identified similar levels of morphological diversity index (MDI) in the three species, but higher genetic diversity in A. inaequidens (MDI = 0.401-0.435; HE = 0.704-0.733), than in A. cupreata (MDI = 0.455-0.523; HE = 0.480-0.510) and the predominantly vegetative propagated crop A. hookeri (MDI = 0.335-0.688; HE = 0.450-0.567), a pattern consistent with our expectations. The morphological and genetic similarities between cultivated A. inaequidens and A. hookeri support the hypothetical evolutionary relationships among these species, but studies with cpDNA and SNPs, and including other member of the Crenatae group are necessary to further resolve these relationships.

Hepatocarcinoma: frecuencia en el servicio de gastroenterología del hospital militar “Dr. Carlos Arvelo” en 5 años / Hepatocellular carcinoma: frequency in the service gastroenterology of hospital militar

El hepatocarcinoma es la neoplasia primaria hepática más frecuente con una incidencia creciente en todo el mundo cuyo pronóstico está ligado con el diagnóstico temprano. Determinar la frecuencia del hepatocarcinoma en pacientes del Servicio de Gastroenterología del Hospital Militar "Dr. Carlos Arvelo" durante el período 2006-2011. Trabajo retrospectivo y descriptivo. Se recolectaron historias médicas de 39 pacientes con ese diagnóstico. Los rasgos demográficos fueron similares a los descritos en Occidente: predominio hombres (71,79%), edad promedio entre 60 y 69 años (35,8%). La primera causa fue por hepatitis C (35,89%), seguida por el alcohol (25,64%) y hepatitis B (15,38%). Para estadificación se usaron los criterios Barcelona Clinic Liver Cancer, siendo al momento del diagnóstico el estadio D el más frecuente (68,57%). El 28,20% recibió tratamiento. Sorafenib fue lo más utilizado, (7 pacientes) dado que ingresaban al Hospital en estadio terminal limitando las opciones terapéuticas. El 12,8% de los pacientes estaban vivos al momento de realizar el estudio. El hepatocarcinoma es un tumor raro en nuestro medio. Frecuentemente produce pocos síntomas, manifestándose como descompensación de la función hepática en pacientes con cirrosis por lo que debe intensificarse la pesquisa, para lograr diagnóstico temprano y mejorar el pronóstico

Hepatocellular carcinoma is the most common primary neoplasm liver with an increasing incidence worldwide whose prognosis is linked to early diagnosis. To determine the frequency of hepatocellular carcinoma in patients from the Gastroenterology Service of the Military Hospital "Dr. Carlos Arvelo" during the period 2006-2011. Retrospective and descriptive. Were collected from medical records of 39 patients with that diagnosis. The demographic features were similar to those described in the West: predominantly men (71.79%), average age between 60 and 69 (35.8%). The first cause was hepatitis C (35.89%), followed by alcohol (25.64%) and hepatitis B (15.38%). For staging criteria were used Barcelona Clinic Liver Cancer, being at the time of diagnosis, stage D the most common (68.57%). The 28.20% received treatment. Sorafenib was the most used, (7 patients) admitted to the hospital since end-stage limiting therapeutic options. 12.8% of patients were alive at the time of the study. Hepatocellular carcinoma is a rare tumor in our environment. Often produces few symptoms, manifesting as decompensation of liver function in patients with cirrhosis and should be intensified screening to achieve early diagnosis and improve prognosis

Trombosis de la vena porta: a propósito de 4 casos en el Hospital Militar “Dr. Carlos Arvelo” / Portal vein thrombosis: with regard to 4 cases in Hospital Militar

La trombosis venosa portal es una oclusión de la misma por un coágulo y/o trombo; o por otras causas como cirrosis, cáncer de hígado, páncreas o estómago. Afecta únicamente al tronco portal. En ausencia de un tumor maligno que invada o comprima el eje esplenoportal, la trombosis es el mecanismo etiopatogénico más frecuente que ocasiona la obstrucción venosa. Según las series estudiadas en un 7%-22% de los pacientes con trombosis portal no se identifica una condición protrombótica (trombosis portal idiopática). No obstante, en el resto de ocasiones en un 40% de casos existe un factor local desencadenante y en un 60% de casos restantes factores trombogénicos sistémicos. En más de un 15 % de estos pacientes coexisten factores etiológicos múltiples. Las consecuencias clínicas de la trombosis venosa del eje esplenoportal dependen del momento evolutivo en el que se encuentre ésta, pero también de la extensión del trombo. La principal manifestación suele ser el dolor abdominal, con frecuencia irradiado a espalda. Pueden aparecer síntomas inespecíficos como fiebre sin foco conocido, síntomas dispépticos (náuseas y plenitud postprandial) y malestar general. Los parámetros de función hepática, albúmina y tiempo de protrombina muestran mínimas alteraciones. En este trabajo quisimos exponer 4 casos de pacientes de nuestro centro a los cuales se les realizó el diagnóstico de trombosis de la vena porta, con edades comprendidas entre 30-60 años, con predominio del sexo masculino, y quienes han cumplido regularmente su tratamiento no presentando complicaciones durante su evolución, manteniéndose estables en su control entre 2003 y 2009...

Portal vein thrombosis is its occlusion by a clot and/or thrombus, or by other causes such as cirrhosis, cancer of liver, pancreas or stomach. It affects the portal trunk only. Whenever a malignant tumor invading or compressing the splenoportal axis is not present, thrombosis is the most frequent ethiopathogenetic mechanism causing vein obstruction. According to the studied series, in 7-22% of patients with portal thrombosis no prothrombotic condition (idiopathic portal thrombosis) is identified. However, in 40% of the remaining cases there is a local triggering factor, and the other 60% shows systemic thrombogenetic factors. Multiple etiologic factors coexist in over 15% of said patients. The clinical consequences of the splenoportal axis vein thrombosis depend on the evolution momentum where the thrombosis is found, and also on the thrombus’ dimension. Abdominal pain could be the main manifestation, frequently irradiated to the back. Non-specific symptoms could appear, such as fever of unknown origin, dyspeptic symptoms (nausea and postprandial fullness), and general malaise. The parameters of hepatic function, albumin, and of prothrombin time show minimal changes. In this study the cases of 4 patients of this health center were exposed; said patients were diagnosed with portal vein thrombosis and were of ages ranging 30-60, male-sex prevalence, who regularly followed their treatment and did not present complication in their evolution, staying stable in their 2003 and 2009 control...

Dilatación neumática en acalasia: Experiencia a corto plazo con balones de diferentes diámetros

Introducción: la acalasia es un trastorno motor primario de etiología desconocida que afecta el esófago. Afecta ambos sexos y la disfagia es el síntoma cardinal (93%). Relajación inefectiva del esfínter esofágico inferior combinado con pérdida del peristaltismo esofágico impiden su vaciamiento y lo dilatan progresivamente. La dilatación neumática es en la actualidad el tratamiento de elección. Dilatación a demanda iniciando con 3 cm e incrementando el diámetro según respuesta, o iniciar con 3,5 cms son las dos corrientes actuales. Materiales y Métodos: 16 Pacientes con diagnóstico de acalasia. Grupo 1: 10 pacientes se dilataron de inicio con balón de 3 cm y luego opcionalmente con 3,5 cm de presentar nuevamente disfagia, 2 pacientes tenían Miotomía de Heller previa. Grupo 2: 6 pacientes se dilataron primariamente con balón de 3,5 cm. Resultados: el 60% de los dilatados con 3 cm presentaron disfagia entre 6 y 12 semanas después re-dilatándose luego con balón 3,5 cm. Un paciente presentó perforación y otro presento carcinoma epidermoide. Discusión: la dilatación neumática con balón es bien tolerada. No hubo mortalidad asociada al procedimiento. La disfagia mejoró rápidamente. Conclusión: Es una serie de corto seguimiento pero refleja una experiencia local importante, es necesario un seguimiento a largo plazo.

Introduction: Achalasia is a primary esophageal motor disorder of unknown etiology. It affects both sexes, and dysphagia is the cardinal symptom (93%). Ineffective relaxation of the lower esophageal sphincter combined with loss of the esophageal peristalsis leads to impaired emptying and gradual esophageal dilatation. Pneumatic dilation is at the present time the treatment of election. Dilatation to demand beginning with 3 cm and increasing the diameter according to the response, or beginning with 3,5 cm are actually the actual currents. Materials and Methods: 16 patients with diagnosis of achalasia. Group 1: 10 patients were dilatated beginning with a 3 cm baloon and then with 3, 5 cm in those who presented dysphagia again, 2 patients had a previous Heller myotomy. Group 2: 6 patients were dilatated primarily with a 3, 5 cm baloon. Results: 60% of the patients who were dilatated with 3 cm presented dysphagia 6 -12 weeks later, being redilatated with a 3, 5 cm baloon. A patient presented perforation and another one presented squamous cell carcinoma. Discussion: Pneumatic balloon dilatation is well tolerated. There was not any mortality caused by the procedure and dysfagia improved quickly. Conclusion: it is a short term follow up series but it reflects an important local experience, being necessary a longer term.

Lupus eritematoso sistémico: calcio e inmunorregulación / Systemic lupus erythematosus: calcium and immunoregulation

La utilización del calcio in vitro se ha involucrado con la elevación de los niveles de interleucina sérica y éstas moléculas estimulan la producción de los linfocitos. Se realizó un ensayo clínico fase II temprana con el objetivo de determinar si la administración de calcio por vía oral a los pacientes con LUPUS, provoca un aumento del los niveles de linfocitos T, y en particular a los linfocitos T supresores, para mejorar la clínica. De ser así, se podría utilizar el calcio como parte del arsenal terapéutico en este grupo de pacientes. Se estudiaron 12 pacientes con lupus en el período de tres meses. Los pacientes fueron escogidos al azar y se conformaron dos grupos, uno que recibió 600 mgrs de calcio al día en forma de carbonato de calcio (A) (6 pacientes) y otro que recibió placebo (B) (6 pacientes). Antes de comenzar la administración del calcio o del placebo, a cada paciente se le practicó una evaluación clínica, hematología completa, subpoblación linfocitaria, creatinina sérica, examen simple de orina y electrocardiograma. Todos los pacientes fueron seguidos por tres meses y al final del estudio se repitieron las pruebas iniciales. No hubo diferencias clínicas entre los pacientes que recibieron calcio y los que recibieron placebo. Tres (50 por ciento) de los pacientes que recibieron calcio mostraron una disminución de los leucocitos totales al igual que el grupo que recibió placebo. Cuatro (66.6 por ciento) de los pacientes del grupo A mostraron una disminución del conteo de linfocitos totales y sólo dos (33.3 por ciento) de los pacientes del grupo B (F = 0.089). Cinco (83.3 por ciento) de los pacientes que recibieron calcio mostraron una elevación de los niveles de linfocitos CD3 en contra de dos (33.3 por ciento) de los pacientes que recibieron placebo (F = 3.2449). Tres (50 por ciento) de los pacientes del grupo A elevaron los niveles de linfocitos CD4 y dos (33.3 por ciento) del grupo B (F = 0.024). Cuatro (66.6 por ciento) de los pacientes que recibieron calcio presentaron elevación de los linfocitos CD8, en contra de uno (16.6 por ciento) de los que recibieron placebo (F = 2.444). Todos los resultados se interpretaron en la tabla de Fisher con un nivel de 0.05. No hubo diferencias estadísticas significativas entre los grupos, respecto a los otros estudios paraclínicos realizados(AU)